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State Medicaid news: Jul 28, 2015

Connecticut's new two year budget, which took effect on July 1st, reduced income eligibility for Medicaid parents and relative caregivers from 201% of the federal poverty level (FPL) to 155% FPL. This change impacts nearly 1,300 enrollees, who will become ineligible for the program starting September 1. In anticipation of the reduction in eligibility, Access Health CT, the State's health insurance Marketplace, has been meeting with insurance brokers, community health centers and other stakeholders to ensure they are prepared to help these individuals enroll in the marketplace and not face a gap in coverage. The State is also planning to reach out through letters and phone calls to notify consumers about their Access CT options.

A federal judge ruled late last week that participating Medicaid Cook County healthcare providers must be paid for services immediately, even as the State government remains shut down after the legislature and the Governor failed to agree on a strategy for balancing the budget earlier this month. The lawsuit, brought by the Sargent Shriver National Center on Poverty Law on behalf of Cook County children, contended that failure to pay providers could lead to denial of care for children covered under a 2005 consent decree that obligates Cook County to comply with the federal requirements to insure Medicaid children. The ruling may have statewide implications for Medicaid payments.

Massachusetts: Medicaid Redetermination Process Notifies More Than Half a Million of Need to Reapply

As Massachusetts conducts its first Medicaid eligibility redeterminations since 2013, the Associated Press reports that more than 500,000 beneficiaries were notified of the need to reapply for benefits. Of those who have responded and been processed by the State, 78% (approximately 293,000 individuals) remained eligible. Around 116,000 individuals have yet to respond to multiple notifications and, if they fail to complete the redetermination process, their coverage will end. The redeterminations were estimated to save nearly $200 million and were included in the most recent state budget. Final figures are expected from the State on August 1.

Rhode Island: Governor Establishes Working Group for Healthcare Innovation

Governor Gina Raimondo (D) issued an Executive Order establishing a working group tasked with lowering costs for publicly and privately funded healthcare, improving care quality and health outcomes, coordinating existing reform initiatives, and expanding those initiatives into privately funded healthcare. Members of the working group will be appointed by the Governor and will build on the recommendations made by the state’s Working Group to Reinvent Medicaid. Specific deliverables include a proposed spending cap for publicly and privately funded healthcare, guidance on achieving value-based payments at a rate of 80% of all healthcare spending by 2018, recommendations for establishing a next-generation health IT system, and developing a plan to meet the population health goals defined in the Centers for Disease Control and Prevention’s Healthy People 2020 report. The working group will have its first meeting in August and will present its first report to the Governor no later than December 1, 2015.